Positive Health Online

Abstract

FONNEBO and co-authors, National Research Center in Complementary and Alternative Medicine, Faculty of Medicine, University of Tromso, N-9037 TROMSO, Norway,  Vinjar.Fonnebo@fagmed.uit.no, have investigated the strengths and weaknesses of conventional medical research strategies when applied to CAM therapies.

Abstract: The aim of this study was to explore the strengths and weaknesses of conventional biomedical research strategies and methods as applied to complementary and alternative medicine (CAM), and to suggest a new research framework for assessing these treatment modalities.
There appears to be a gap between published studies showing little or no efficacy of CAM, and reports of substantial clinical benefit from patients and CAM practitioners. This "gap" might be partially due to the current focus on placebo-controlled randomized trials, which are appropriately designed to answer questions about the efficacy and safety of pharmaceutical agents. In an attempt to fit this assessment strategy, complex CAM treatment approaches have been dissected into standardized and often simplified treatment methods, and outcomes have been limited. Unlike conventional medicine, CAM has no regulatory or financial gatekeeper controlling their therapeutic "agents" before they are marketed. Treatments may thus be in widespread use before researchers know of their existence. In addition, the treatments are often provided as an integrated 'whole system' of care, without careful consideration of the safety issue. The authors propose a five-phase strategy for assessing CAM built on the acknowledgement of the inherent, unique aspects of CAM treatments and their regulatory status in most Western countries. These phases comprise:
1. Context, paradigms, philosophical understanding and utilization
2. Safety status
3. Comparative effectiveness.
4. Component efficacy
5. Biological mechanisms.
Using the proposed strategy will generate evidence relevant to clinical practice, while acknowledging the absence of regulatory and financial gatekeepers for CAM. It will also emphasize the important but subtle differences between CAM and conventional medical practice.

Background

Methodology

Results

Conclusion

References

Fonnebo V et al. Researching complementary and alternative treatments--the gatekeepers are not at home. BMC Medical Research Methodology 7 : 7, 2007.

Comment

The above 2 studies have interesting and potentially far-reaching findings: The first study by Chaterji regarding the teaching of complementary medicine to medical students points to the real progress which has been made to bridge the divide between so-called conventional and alternative medicine, a semantic misnomer if ever there was one. The second study by Fonnebo states in clear language the problem between the research models for pharmaceutical drug testing and complementary and/or integrated systems of care. The author’s five-phase strategy are an excellent guide regarding research methodologies.